Organization
DIABETES EDUCATION AND WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENALYN CANULLAS (PROGRAM COORDINATOR)
(732) 500-1477
Entity
Organization
Contact information
Practice address
1 MAIN ST, SUITE 226, EATONTOWN, NJ 07724-3450
(732) 500-1477
Mailing address
352 BROAD ST, EATONTOWN, NJ 07724-1616
(732) 500-1477
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
01/12/2015
Last updated
02/25/2015
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